A sewing needle in the liver. (Case Report).Abstract An 85-year-old woman with Alzheimer's dementia was hospitalized because of prolonged fever, breathlessness, and generalized pain. Blood analysis showed an elevated erythrocyte sedimentation rate Erythrocyte Sedimentation Rate Definition The erythrocyte sedimentation rate (ESR), or sedimentation rate (sed rate), is a measure of the settling of red blood cells in a tube of blood during one hour. , and temporal artery biopsy showed giant cell arteritis giant cell arteritis n. See temporal arteritis. Giant cell arteritis Also called temporal arteritis. A condition which causes the inflammation of temporal arteries. . Prednisone therapy was instituted, and the patient's condition partially improved. Incidentally, abdominal radiographs revealed a sewing needle in the right upper quadrant right upper quadrant Physical exam The abdominal region that contains the liver, duodenum and head of pancreas , and computed tomography (CT) showed that the needle was lodged in the liver parenchyma Parenchyma A ground tissue of plants chiefly concerned with the manufacture and storage of food. The primary functions of plants, such as photosynthesis, assimilation, respiration, storage, secretion, and excretion—those associated with living . ********** Demented adults and children frequently swallow foreign bodies, which usually pass through the gastrointestinal tract uneventfully. Nevertheless, silent gastrointestinal perforation and migration of the foreign body throughout the abdominal cavity may also occur, illustrating that there are no insurmountable barriers in the pathways of foreign bodies. (1-3) We describe a demented patient who had prolonged fever and who was incidentally found to have a sewing needle in her liver. Presumably pre·sum·a·ble adj. That can be presumed or taken for granted; reasonable as a supposition: presumable causes of the disaster. , she had inadvertently swallowed the foreign body before. Accepted February 26, 2002. References (1.) de la Vega de la Vega is a common surname in the Spanish language meaning "of the plain" and may refer to: People (arranged by date of birth)
(2.) John KD, Segal I, Saadia R. Perforation of the gastro-intestinal tract by a foreign body: A case report. S Afr J Surg 1996;34:78-80. (3.) Crankson SJ. Hepatic foreign body in a child. Pediatr Surg Int 1997;12: 426-427. RELATED ARTICLE: Key Points * Older adult patients with dementia may swallow foreign bodies, which usually pass through the gastrointestinal tract uneventfully. * Silent gastrointestinal perforation and migration of foreign bodies throughout the abdominal cavity may occur in these patients. Case Report An 85-year-old woman with Alzheimer's dementia was admitted because of a 4-week history of fever, breathlessness, and generalized pain. Her medical history also included a left hip fracture. On examination, the patient was apathetic, disoriented, and febrile. The temporal arteries appeared normal. The abdomen was tender to palpation palpation /pal·pa·tion/ (pal-pa´shun) the act of feeling with the hand; the application of the fingers with light pressure to the surface of the body for the purpose of determining the condition of the parts beneath in physical diagnosis. , but there were no signs of peritoneal peritoneal /peri·to·ne·al/ (per?i-to-ne´al) pertaining to the peritoneum. peritoneal pertaining to the peritoneum. irritation. Blood analysis showed erythrocyte sedimentation rate of 120 mm/h, mild normocytic anemia, slightly increased white blood cell count white blood cell count, n a diagnostic clinical laboratory test to determine the number and types of leukocytes present in a measured sample of blood. Overall the normal number of leukocytes ranges from 5000 to 10,000/mm3. with left shift, and moderate elevation of alkaline phosphatase. Results of blood cultures and other microbiology studies were negative. Findings on electrocardiogram, echocardio gram, and chest radiograph were normal. Abdominal radiographs revealed a sewing needle in the right upper quadrant (Fig. I), and computed tomography showed that the needle was lodged in the liver parenchyma, just beneath its capsule (Fig. 2). A right temporal artery biopsy disclosed giant cell arteritis. High-dose prednisone therapy was instituted. During the next few days, the patient's fever disappeared and her general condition partially improved. From the Department of Medicine, Hospital General of Castellon, Castellon, Spain. Reprint requests to Bernardino Roca, MD, PhD, Catalunya, 33-A, 4, 12004 Castellon, Spain. Email: brocav@meditex.es Copyright (c) 2003 by The Southern Medical Association 0038-4348/03/9606-0616 |
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